Copyright ©The Author(s) 2018.
World J Gastroenterol. Jun 7, 2018; 24(21): 2247-2260
Published online Jun 7, 2018. doi: 10.3748/wjg.v24.i21.2247
Table 1 Studies involving laparoscopic colorectal procedures with left-sided anastomosis
AuthorYearNo. of patientsOverall leak rate (n)Risk factor identified
Ito et al[8]20081805.0% (9)TME
N° of staplers firing (≥ 3)
Kim et al[36]20082666.4% (17)Male sex
Pugliese et al[66]200815710.8% (17)Conversion
Kim et al[47]20092706.3% (17)Tumor location in middle or lower rectum
Zhu et al[40]20101329.1% (12)Tumor size (diameter ≥ 3 cm)
Distance from the anal verge (≤ 6 cm)
TNM stage
Choi et al[45]201015610.3% (16)Anastomotic level ≤ 5 cm from the anal verge
Long operation time (≥ 270 min)
Huh et al[46]20102238.5% (19)Extraperitoneal location of tumor
Operative time > 220 min
Kayano et al[41]201125010.0% (25)Male sex
Multiple stapler firings (≥ 2)
Akiyoshi et al[49]20113633.6% (13)Middle/low rectal cancer
Lack of pelvic drain
Yamamoto et al[39]20121115.4 (6)BMI
Hinoi et al[68]20138889.3% (83)LCA ligation in LAR
Park et al[34]201316096.3% (101)Male sex
Low anastomosis (< 7 cm)
Preoperative chemoradiation
Advanced tumor stage
Perioperative bleeding (≥ 2 transfusions)
Multiple firings of the linear stapler (> 3)
Kawada et al[42]201415412.3% (19)Tumor size > 5 cm
Operative time > 300 min
Intraoperative bleeding > 100 mL
Stapler firings > 3
Precompression before stapler firing
Majbar et al[65]201613116.0% (21)Conversion to open surgery
Silva-Velazco et al[38]201610599% (95)BMI ≥ 35 kg/m2
N° of staplers firing
Longer operative time
Van Praagh et al[74]20161650% (8)Low diversity of gut microbiota
High presence of Lachnospiraceae
Hamabe et al[35]20172968.1% (24)Male sex
Distance from anal verge < 7 cm
Neoadjuvant chemotherapy
Lee et al[48]20171280.78% (1)Stapler firings > 2
Distance from anal verge
Tanaka et al[37]20173958.4% (33)Male sex
Absence of transanal tube
Ito et al[44]20176915.9% (11)Absence of transanal tube
Post-operative diarrhea
Shimura et al[43]20181965.61% (11)Post-operative hypoalbuminemia
Van Praagh et al[75]201812323.6% (29)Bacteroidaceae
Low diversity of gut microbiota
High presence of Lachnospiraceae
Anostomosis covered with C-Seal
Table 2 Studies involving both right and left-sided anastomoses
AuthorYearNo. of patientsOverall leak rate (n)Risk factor identified
Kockerling et al[82]19998944.2% (38)Rectal resection
Malignant disease
Anastomotic level < 10 cm from the anal verge
Senagore et al[80]20032602.7% (7)BMI ≥ 30 kg/m2
Kirchhoff et al[83]2008131627.7% (59)BMI ≥ 30 kg/m2
Male gender
Malignant neoplasia
Akiyoshi et al[79]201111941.0% (12)BMI ≥ 30 kg/m2
Rectal tumor location
Ris et al[90]20185042.4% (12)No use of indocyanine green